What is “translational research”? – an example with premature babies

Some news to announce here – in September 2014 I’ll be transferring from my current base in the School of Education to a home in part of the College of Medicine and Veterinary Medicine here at the University of Edinburgh.  This new role reflects the fact that my work has been moving in a more and more clinical direction over the past few years, but also that my colleagues in Medicine are pursuing a commitment to translational research.

To be perfectly frank, translational research is one of those terms, like interdisciplinarity, that I use freely but am also unsure about.  I am confident I can tell the difference between research which is and which isn’t translational, but I’m hard pushed to define independently what it means. Plus different people probably use the term in different ways. But here’s an example of some research I’m involved in, which I think is translational.

BrZrNr8IMAAbfHY.jpg_largeColleagues from the Patrick Wild Centre, in collaboration with the charity Mindroom, recently held an exhibition in St Andrew’s Square in Edinburgh, showcasing some of the beautiful images produced from their neuroscientific investigations.  You can see a buzzfeed of some of the best images here.

One image, recently selected as picture of the week by the BMJ, shows the connectivity of the typical infant and older adult brains. Here I am at the exhibition, posing next to it with my daughter (who was under the impression that the brains featured were hers and mine!). By ‘connectivity’ I mean these images show a map of the major white matter (as opposed to grey matter) tracts which join up different brain regions.  Building on this work, which was led by my collaborators James Boardman and Mark Bastin, we are now investigating whether this kind of white matter map looks different in the brains of babies born prematurely, at less than 32 weeks into the pregnancy.

So far, this is not very translational.  While I believe this basic science has inherent value, what it means to a parent of a baby born preterm, or to nurses and doctors on the neonatal wards, remains unclear.  This is where psychology comes in.  As well as recording brains scans from newborn babies, we are also inviting them for some eye-tracking assessments at about 9 months old. I won’t get bogged down in eye-tracking right now (I’ll save that for another blog post).  Suffice to say, if we know where you are looking, we can have some insight into what you are thinking.  This is obviously a great method for understanding what’s going on in the brains of babies, as they can’t answer any questions yet, but they can look at pictures.

The eye-tracking tasks we’ve designed for the babies will reveal things like how efficient they are at moving their eyes (and therefore attention) from one thing to another; how long they can remember things for; and whether they are more interested in faces than anything else. Here’s a link to a video of the tasks. Once we have this information we can relate the patterns we find in how babies think at 9 months with how their brains look when they’re born.

premature baby picSo what makes this translational?  Well, instead of just saying “some babies born preterm have different brains” we can then say “some babies born preterm have different brains and this affects their memory”.  We’ve translated the information from the brain scans into something which makes sense in real life. Something we can do something about.

Why not just do the memory task then?  If that’s the bit which makes sense in real life?  Well, there are a few reasons.

Lots of babies born preterm – even those born very early – will go on to be fine and not need any extra help, but some will have difficulties with learning. Because these are often subtle, they might not be picked up until the child starts school. We want to spot the children who need extra help when they’re younger, but we don’t want to waste precious time and resources on a child who is going to be perfectly fine – or make their parents anxious for no reason. So, one goal of our research is to try to work out exactly which babies need extra help. This is trickier that it might seem and we think that our best chance of finding early signs of later difficulties is to combine methods. Relying on just one piece of data – like a brain scan, or results on an eye-tracking task – is less reliable.  What if the baby was just having a bad day when they came to do the eye-tracking? What if their brain looks a wee bit unusual, but not really obviously different?  Using multiple methods gives us a much stronger way to work out what early signs are linked to later difficulties.

Another reason to use the scans is that we want to start providing extra support, if it is needed, as early as possible. Babies can’t do much just after they’re born, but they can sleep and that’s all they need to do to have a successful brain scan.  In the future we might be able to use a newborn scan to spot babies who need some extra help.  In that case, the eye-tracking gives us a clue as to what skills we should be focusing on when we give that extra help – attention, memory, social interest and so on.

This translational process is pretty slow.  The oldest babies in our study are coming up to 2 years old, but it’ll be a long time before they’re all in school and we can start to look at the really long-term outcomes. Because the methods we’re using are very new as well (just making a single map like the one in the picture above is pretty amazing), we will want to have plenty of data before we make any bold statements about how newborn brain connections predict later abilities or difficulties. And then the next stage will be to think about whether we should change the way babies are cared for on the neonatal ward, or at home, to help their brains make good connections. But it is happening.  This basic science – how do we a scan baby brain? what does a baby brain look like? – will one day yield information which will help us give every newborn the best possible start in life.

If you’re a parent of a baby born prematurely or otherwise want to find resources to help you understand premature birth, this website has some good information.